Hydrocephalus is a condition afflicting patients who are unable to regulate cerebrospinal fluid flow through their body's own natural pathways. Produced by the ventricular system, cerebrospinal fluid (CSF) is normally absorbed by the body's venous system. In a patient suffering from hydrocephalus, the cerebrospinal fluid is not absorbed in this manner, but instead accumulates in the ventricles of the patient's brain. If left untreated, the increasing volume of fluid elevates the patient's intracranial pressure and can lead to serious medical conditions such as compression of the brain tissue and impaired blood flow to the brain.
The treatment of hydrocephalus has conventionally involved draining the excess fluid away from the ventricles and rerouting the cerebrospinal fluid to another area of the patient's body, such as the abdomen or vascular system. A drainage system, commonly referred to as a shunt, is often used to carry out the transfer of fluid. In order to install the shunt, typically a scalp incision is made and a small hole is drilled in the skull. A proximal, or ventricular, catheter is installed in the ventricular cavity of the patient's brain, while a distal, or drainage, catheter is installed in that portion of the patient's body where the excess fluid is to be reintroduced.
To regulate the flow of cerebrospinal fluid and maintain the proper pressure in the ventricles, a pump or one-way control valve can be placed between the proximal and distal catheters. Generally, the shunt systems include a valve mechanism that operates to permit fluid flow only once the fluid pressure reaches a certain threshold level. That is, fluid enters the valve only when the fluid pressure overcomes the valve mechanism's resistance to open. Some valve mechanisms permit the adjustment, or programming, of the opening pressure level, or resistance level, at which fluid flow commences. These valve mechanisms can comprise a variety of configurations. For example, the valve mechanism can be configured as a ball-in-cone as illustrated and described in U.S. Pat. Nos. 3,886,948, 4,332,255, 4,387,715, 4,551,128, 4,595,390, 4,615,691, 4,772,257, and 5,928,182, all of which are hereby incorporated by reference.
An essential goal of any hydrocephalus treatment and moreover of any hydrocephalus shunt system is to restore the balance between the formation and absorption of CSF in the patient. Research in this area has shown that, while the formation rate is insensitive to pressure, the absorption rate increases linearly with increasing pressure. Moreover, the formation and absorption rates vary significantly from patient to patient, with age and with the circadian cycle. Specifically, CSF formation rate increases with age starting from infancy to adulthood, but then continuously declines with age following adulthood. More importantly, the natural residual absorption rate in hydrocephalus patients varies from patient to patient. This patient-specific absorption rate determines the degree of shunt dependency for that particular patient. Due to these variations in CSF absorption and formation rates, it is nearly impossible to predict the necessary resistance level of the hydrocephalus valve that will lead to the restoration of normal physiologic pressures in the patient's brain ventricles.
Valve mechanisms that continuously drain CSF are well known, as are valve mechanisms that control and/or adjust the opening pressure and/or drainage rate of the patient's CSF. However, these valve mechanisms respond to the instantaneous fluid flow or pressure in the ventricles to achieve a predetermined pressure or flow rate. This artificially prescribed flow rate prevents normal physiologic pressure waveforms from occurring and it is suspected that the resulting unnatural pressure waveforms are responsible for the late development that is frequently seen in hydrocephalus. Current devices attempt to restore normal physiologic pressure waveforms by providing ways to adjust, or program, the opening pressure of the valve. However, these current devices still provide less than ideal results. There is thus a need for a simple valve device that will adjust its resistance to the patient's conditions, and which takes into account the variability of the absorption and formation rates of the patient over time.